| NPI | 1700183605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: LA 232160) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP70049218) |
| 163W00000X Registered Nurse (Licence: LA 106340) | |
| Enumeration Date | 2011-02-12 |
| Last Update Date | 2025-10-16 |