| NPI | 1194014589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA RN60732760) |
| Additional Taxonomies | 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: NV 64777) |
| 163W00000X Registered Nurse (Licence: NV 64777) | |
| 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: WA RN60732760) | |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: NV 64777) | |
| Enumeration Date | 2011-04-06 |
| Last Update Date | 2022-05-24 |