| NPI | 1477851475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61234580) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NC C008166) |
| 163W00000X Registered Nurse (Licence: TX 974125) | |
| 163W00000X Registered Nurse (Licence: WA RN61227134) | |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2024-08-17 |