| NPI | 1568936318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61637104) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60784261) |
| Enumeration Date | 2019-01-15 |
| Last Update Date | 2025-03-07 |