| NPI | 1255090478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA ARNP.AP.70113556-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA 61039456) |
| Enumeration Date | 2021-12-15 |
| Last Update Date | 2026-04-07 |