| NPI | 1619393204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP 60451837) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WA AP60451837) |
| Enumeration Date | 2014-03-06 |
| Last Update Date | 2022-09-28 |