| NPI | 1326181397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ 253356) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 7398) |
| 246ZE0600X Specialist/Technologist, Other, Electroneurodiagnostic | |
| 363LF0000X Nurse Practitioner, Family (Licence: AZ RNP253356) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2025-07-21 |