| NPI | 1689431991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61591063) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 301785) |
| 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA N361592191) | |
| Enumeration Date | 2024-03-04 |
| Last Update Date | 2024-08-08 |