| NPI | 1912362427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP60630465) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60287540) |
| Enumeration Date | 2015-12-28 |
| Last Update Date | 2016-03-14 |