| NPI | 1669739090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: OR 201240343RN) |
| Additional Taxonomies | 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: WA RN60234187) |
| Enumeration Date | 2012-04-23 |
| Last Update Date | 2012-04-23 |