| NPI | 1053925834 |
|---|---|
| Former Name | MARCELLIS DANTE DODSON-SMITH |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61446508) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA 60767182) |
| Enumeration Date | 2020-08-31 |
| Last Update Date | 2023-07-09 |