| NPI | 1407198039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 24760) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 8319) |
| Enumeration Date | 2013-03-21 |
| Last Update Date | 2023-05-17 |