| NPI | 1720397367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OR 201604952RN) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: OR 201604952RN) | |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2025-01-23 |