| NPI | 1619109774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WA AP60201664) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00174674) |
| Enumeration Date | 2009-08-21 |
| Last Update Date | 2015-08-07 |