| NPI | 1891300398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61451238) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN00146141) |
| Enumeration Date | 2020-09-11 |
| Last Update Date | 2025-05-06 |