| NPI | 1982079117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA ARNP.AP.70058768) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: OR 201507426RN) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: WA RN61066430) | |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2025-11-26 |