| NPI | 1891871356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 200450127NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 200243020RN) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2007-08-21 |