| NPI | 1841766748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60989613) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60766087) |
| Enumeration Date | 2018-10-17 |
| Last Update Date | 2021-06-17 |