| NPI | 1043550700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61166261) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 163W00000X Registered Nurse (Licence: WA 60860852) | |
| Enumeration Date | 2013-02-18 |
| Last Update Date | 2021-09-22 |