| NPI | 1407808074 |
|---|---|
| Other Name | WOODY GLADE |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP30004465) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00114137) |
| 363L00000X Nurse Practitioner (Licence: WA AP30004465) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2013-06-06 |