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 |