| NPI | 1033384987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP30007841) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH00008874) |
| 163W00000X Registered Nurse (Licence: WA RN00161905) | |
| 363LA2200X Nurse Practitioner, Adult Health (Licence: WA AP30007841) | |
| Enumeration Date | 2008-04-22 |
| Last Update Date | 2018-12-13 |