| NPI | 1225681398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61679982) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL 11003356) |
| 363LF0000X Nurse Practitioner, Family (Licence: WA AP61679982) | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11003356) | |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2025-06-05 |