| NPI | 1891081717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61004258) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA 60186835) |
| Enumeration Date | 2011-06-20 |
| Last Update Date | 2023-08-04 |