| NPI | 1093246928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60755716) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA RN00173217) |
| Enumeration Date | 2017-03-22 |
| Last Update Date | 2017-05-13 |