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