| NPI | 1982016382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61181160) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: OR 201707698RN) |
| 163W00000X Registered Nurse (Licence: WA RN60980096) | |
| 225700000X Massage Therapist (Licence: IL 227.016193) | |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2021-07-01 |