| NPI | 1508588401 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61584459) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60378037) |
| 163WS0200X Registered Nurse, School (Licence: WA RN60378037) | |
| Enumeration Date | 2022-09-16 |
| Last Update Date | 2024-12-16 |