| NPI | 1508071473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TP0016X Psychologist, Prescribing (Medical) (Licence: OR 200150020NP PMHNP-PP) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: OR 200150020NP PMHNP-PP) |
| Enumeration Date | 2007-05-13 |
| Last Update Date | 2007-07-08 |