| NPI | 1063074722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61117435) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN695718) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: PA SP020775) | |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2021-06-07 |