| NPI | 1639110281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP30007024) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: WA AP30007024) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2020-11-26 |