| NPI | 1467107474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61331425) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60965690) |
| Enumeration Date | 2022-02-17 |
| Last Update Date | 2022-07-29 |