| NPI | 1659040962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: WA 70109169) |
| Additional Taxonomies | 101Y00000X Counselor |
| 171M00000X Case Manager/Care Coordinator (Licence: WA CG61106670) | |
| Enumeration Date | 2021-09-09 |
| Last Update Date | 2026-05-18 |