| NPI | 1548885916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61092215) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60130171) |
| Enumeration Date | 2020-06-11 |
| Last Update Date | 2022-01-11 |