| NPI | 1184818080 |
|---|---|
| Former Name | JENNIFER BALLIN |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 200750104NP) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OR 200542475RN) |
| Enumeration Date | 2007-09-04 |
| Last Update Date | 2012-11-01 |