| NPI | 1750176517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CAAR.CG.61685564) |
| Additional Taxonomies | 246Q00000X Spec/Tech, Pathology (Licence: WA MAHC.HT.61556351) |
| Enumeration Date | 2025-04-11 |
| Last Update Date | 2026-08-21 |