| NPI | 1962287268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: WA ARNP.AP.61478118-NP) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WA RN.RN.61091961) |
| Enumeration Date | 2023-08-28 |
| Last Update Date | 2026-08-14 |