| NPI | 1972758498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WA AP60389430) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WA CH 00034827) |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2015-05-21 |