| NPI | 1316604473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WA AP61555499) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN61095751) |
| Enumeration Date | 2021-11-23 |
| Last Update Date | 2024-09-19 |