| NPI | 1912445941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OR 20014909RN) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: OR 20014909RN) |
| Enumeration Date | 2017-02-09 |
| Last Update Date | 2017-02-17 |