| NPI | 1417000118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP30005925) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00126135) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2011-04-25 |