| NPI | 1114552148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP70065231) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60274410) |
| Enumeration Date | 2020-03-10 |
| Last Update Date | 2026-03-12 |