| NPI | 1700556248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61344818) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60203458) |
| Enumeration Date | 2021-09-16 |
| Last Update Date | 2024-03-12 |