| NPI | 1497939169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60112262) |
| Additional Taxonomies | 106H00000X Marriage & Family Therapist (Licence: IA LMFT) |
| 163W00000X Registered Nurse (Licence: OR 2000743310RN) | |
| 163W00000X Registered Nurse (Licence: WA RN60068534) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 200950081NP) | |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2015-08-17 |