| NPI | 1326756164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61413237) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60457549) |
| 163WA0400X Registered Nurse, Addiction (Substance Use Disorder) (Licence: WA RN60457549) | |
| Enumeration Date | 2022-11-10 |
| Last Update Date | 2023-03-08 |