| NPI | 1942857826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA AP61224381) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN60987545) |
| Enumeration Date | 2019-08-24 |
| Last Update Date | 2022-07-15 |