| NPI | 1467623520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 364SP0809X Clinical Nurse Specialist, Psych/Mental Health, Adult (Licence: WA AP30006965) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH00003805) |
| Enumeration Date | 2008-03-17 |
| Last Update Date | 2009-03-13 |