| NPI | 1467408815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP30005329) |
| Additional Taxonomies | 103T00000X Psychologist (Licence: WA AP30005329) |
| 103T00000X Psychologist (Licence: PY12342713) | |
| 103TB0200X Psychologist, Cognitive & Behavioral (Licence: WA PY00002713) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: ID CNS-11A) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2023-03-07 |