| NPI | 1427644541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WA AP61173856) |
| Additional Taxonomies | 163WG0000X Registered Nurse General Practice (Licence: CA 95185940) |
| 363LF0000X Nurse Practitioner Family (Licence: WA AP61173856) | |
| Enumeration Date | 2020-12-13 |
| Last Update Date | 2024-04-08 |