| NPI | 1780731265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP30006958) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00067869) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2013-08-28 |