NPI | 1255588737 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201401803NP-PP) |
Additional Taxonomies | 101Y00000X Counselor |
Enumeration Date | 2008-08-26 |
Last Update Date | 2018-03-17 |