| NPI | 1467187732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WA AP61481389) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA 61107799) |
| Enumeration Date | 2022-07-20 |
| Last Update Date | 2023-09-06 |