| NPI | 1255089074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61307989) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60201766) |
| Enumeration Date | 2022-03-10 |
| Last Update Date | 2022-06-29 |