| NPI | 1538419692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60399107) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60403160) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: UT 5359524-3102) | |
| Enumeration Date | 2012-09-17 |
| Last Update Date | 2013-09-19 |