NPI | 1104532944 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61475276) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN61094794) |
Enumeration Date | 2023-01-25 |
Last Update Date | 2023-09-06 |