| NPI | 1144946757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP70021445) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN61086796) |
| Enumeration Date | 2022-10-14 |
| Last Update Date | 2025-10-03 |