| NPI | 1023151081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60191026) |
| Additional Taxonomies | 175F00000X Naturopath (Licence: WA NT00001187) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2018-09-06 |