| NPI | 1407915408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: OR 084053069RN) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 084053069N6 PMHNP-PP) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2007-07-08 |