| NPI | 1083849210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 317339) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TN 2342) |
| 163W00000X Registered Nurse (Licence: AZ 317339) | |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2026-06-19 |