| NPI | 1003092982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: WA RC00051075) |
| Additional Taxonomies | 163WR0006X Registered Nurse, Registered Nurse First Assistant (Licence: WA NA00186086) |
| Enumeration Date | 2008-01-10 |
| Last Update Date | 2008-01-10 |