| NPI | 1821637059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163WP0808X Registered Nurse Psychiatric/Mental Health (Licence: WA RN60374347) |
| Additional Taxonomies | 101YM0800X Counselor Mental Health (Licence: WA CG60155719) |
| Enumeration Date | 2020-01-06 |
| Last Update Date | 2023-11-27 |