| NPI | 1043500895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61158206) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60159577) |
| 363L00000X Nurse Practitioner (Licence: WA AP61158206) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP61158206) | |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2023-12-30 |