| NPI | 1376878314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OR 201050181NP) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: OR 200640886 RN) |
| Enumeration Date | 2009-10-08 |
| Last Update Date | 2016-10-28 |