| NPI | 1407553167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61478008) |
| Additional Taxonomies | 163WE0003X Registered Nurse, Emergency (Licence: WA RN60712454) |
| 163WP0809X Registered Nurse, Psych/Mental Health, Adult (Licence: WA RN60712454) | |
| 163WS0121X Registered Nurse, Plastic Surgery (Licence: WA RN60712454) | |
| Enumeration Date | 2023-02-13 |
| Last Update Date | 2023-08-14 |