| NPI | 1720127020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA60604338) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health (Licence: WA LH60136962) |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2018-03-17 |