| NPI | 1508430216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61204499) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60656310) |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2022-03-10 |