| NPI | 1821708058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61510683) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA 61512266) |
| 163W00000X Registered Nurse (Licence: TN RN0000266239) | |
| Enumeration Date | 2022-11-29 |
| Last Update Date | 2024-07-11 |