| NPI | 1588301865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61290388) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN61290357) |
| 163W00000X Registered Nurse (Licence: FL RN9435312) | |
| Enumeration Date | 2022-05-17 |
| Last Update Date | 2022-05-31 |