| NPI | 1821622887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61619553) |
| Additional Taxonomies | 101YM0800X Counselor, Mental Health |
| 363A00000X Physician Assistant (Licence: CA 1226031) | |
| Enumeration Date | 2020-02-28 |
| Last Update Date | 2025-02-20 |