| NPI | 1598957110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 200850118NP) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: WA RN00168895) |
| 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: OR 200642744RN) | |
| Enumeration Date | 2007-08-16 |
| Last Update Date | 2014-10-15 |