| NPI | 1336672849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WA AP61333792) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60970766) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2022-12-07 |