| NPI | 1114654225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61330216) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: WA RN60968949) |
| Enumeration Date | 2022-08-08 |
| Last Update Date | 2022-08-10 |