| NPI | 1336839364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61440868) |
| Additional Taxonomies | 364SP0812X Clinical Nurse Specialist, Psych/Mental Health, Community (Licence: WA AP61440868) |
| 363L00000X Nurse Practitioner (Licence: CA 95027841) | |
| Enumeration Date | 2023-05-12 |
| Last Update Date | 2026-02-04 |