| NPI | 1053929414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61160443) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: WA RN60474418) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-07-21 |
| Last Update Date | 2021-04-01 |