| NPI | 1700158326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61031683) |
| Additional Taxonomies | 101Y00000X Counselor |
| 363AM0700X Physician Assistant, Medical | |
| Enumeration Date | 2012-01-27 |
| Last Update Date | 2025-07-10 |