| NPI | 1194039834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60650646) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA CG60178269) |
| 163W00000X Registered Nurse (Licence: WA RN60218710) | |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2016-04-19 |