| NPI | 1528700309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61280227) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: WA RN60654463) |
| Enumeration Date | 2022-04-11 |
| Last Update Date | 2023-08-17 |