| NPI | 1467428235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP30001957) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA AP30001957) |
| 104100000X Social Worker (Licence: WA LW00004350) | |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2010-09-24 |