| NPI | 1760619258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201050119NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA 2258652) |
| Enumeration Date | 2009-06-11 |
| Last Update Date | 2010-08-17 |