| NPI | 1124279526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60032534) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00166812) |
| 163W00000X Registered Nurse (Licence: TX 721122) | |
| Enumeration Date | 2008-10-03 |
| Last Update Date | 2015-04-02 |