| NPI | 1750994877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health (Licence: WA AP61450295) |
| Additional Taxonomies | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: WA RN60320085) |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2023-10-29 |