| NPI | 1386287340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61393845) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: WA RN60044386) |
| Enumeration Date | 2019-10-23 |
| Last Update Date | 2024-02-25 |