| NPI | 1801594494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA ARNP.AP.70090240-NP) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: GA APRN321972) |
| Enumeration Date | 2023-02-22 |
| Last Update Date | 2026-09-21 |