| NPI | 1689641896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA10000728) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH00006775) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2020-08-05 |