| NPI | 1073877155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60292813) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00174999) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: WA RN00174999) | |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP60292813) | |
| 363LF0000X Nurse Practitioner, Family (Licence: ID 25237) | |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2023-12-21 |