| NPI | 1871020040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WA PA61124921) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: WA LH60460265) |
| 101YM0800X Counselor, Mental Health (Licence: WA LH60460265) | |
| Enumeration Date | 2017-05-18 |
| Last Update Date | 2022-07-21 |