| NPI | 1144992314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61273001) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: WA CP61469690) |
| 163WC1500X Registered Nurse, Community Health (Licence: WA RN60912791) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP61273001) | |
| Enumeration Date | 2021-10-05 |
| Last Update Date | 2023-11-22 |