| NPI | 1841480761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60319975) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OR 201043039RN) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: OR 201250114NP) | |
| 101Y00000X Counselor (Licence: WA RC00057879) | |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2022-09-02 |