| NPI | 1255926853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61318285) |
| Additional Taxonomies | 163WA2000X Registered Nurse, Administrator (Licence: CA 95144496) |
| Enumeration Date | 2021-03-04 |
| Last Update Date | 2025-04-12 |