| NPI | 1831891605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA APTP.N3.70121777) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95326613) |
| 163WP0808X Registered Nurse, Psych/Mental Health (Licence: CA 95326613) | |
| Enumeration Date | 2023-03-17 |
| Last Update Date | 2026-04-16 |