| NPI | 1487926515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: OR 201142212RN) |
| Additional Taxonomies | 104100000X Social Worker |
| 163WP0000X Registered Nurse, Pain Management (Licence: OR 201142212RN) | |
| Enumeration Date | 2012-02-06 |
| Last Update Date | 2012-02-06 |