NPI | 1679790695 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 200750133NP) |
Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OR 099000666RN) |
Enumeration Date | 2007-04-19 |
Last Update Date | 2016-02-16 |