| NPI | 1528461654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA6135957) |
| Additional Taxonomies | 175F00000X Naturopath (Licence: OR 2043) |
| Enumeration Date | 2014-10-03 |
| Last Update Date | 2024-04-18 |