| NPI | 1558855791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: WA AP60858419) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60558463) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA 60858419) | |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2025-10-21 |