| NPI | 1417526930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WA AP61299473) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60989458) |
| Enumeration Date | 2021-06-19 |
| Last Update Date | 2024-09-21 |