| NPI | 1457957532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61372812) |
| Additional Taxonomies | 163WP0808X Registered Nurse, Psych/Mental Health (Licence: FL 9425118) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: FL 11010486) | |
| Enumeration Date | 2020-12-05 |
| Last Update Date | 2022-12-02 |