| NPI | 1265179519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61484384) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60898587) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-05-18 |
| Last Update Date | 2023-10-18 |