| NPI | 1255387783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 364SP0808X Clinical Nurse Specialist Psychiatric/Mental Health (Licence: WA PA10004397) |
| 363AM0700X Physician Assistant Medical (Licence: WA PA10004397) | |
| 364SF0001X Clinical Nurse Specialist Family Health (Licence: WA PA10004397) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2020-07-21 |