| NPI | 1023308954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60684723) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60684722) |
| 163W00000X Registered Nurse (Licence: FL RN9313499) | |
| 363L00000X Nurse Practitioner (Licence: FL ARNP9313499) | |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2023-05-03 |