| NPI | 1154670628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60302056) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60302056) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP60302056) | |
| Enumeration Date | 2012-08-30 |
| Last Update Date | 2024-11-16 |