| NPI | 1821721028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61476819) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60499592) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: WA RN60499592) | |
| Enumeration Date | 2022-07-05 |
| Last Update Date | 2023-08-28 |