| NPI | 1346814035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WA AP61454424) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60765967) |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2023-06-15 |