| NPI | 1578010971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61436618) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60481845) |
| Enumeration Date | 2016-09-02 |
| Last Update Date | 2023-06-26 |