| NPI | 1083819858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: WA AP60408146) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA RC00048583) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2015-12-15 |