| NPI | 1316079544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OR 200642896RN) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 200642896RN) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2009-02-09 |