| NPI | 1427304963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AZ 51454) |
| Additional Taxonomies | 101Y00000X Counselor |
| 102L00000X Psychoanalyst | |
| 103K00000X Behavior Analyst | |
| 103T00000X Psychologist | |
| 133N00000X Nutritionist | |
| 133V00000X Dietitian, Registered | |
| 171M00000X Case Manager/Care Coordinator | |
| 207R00000X Internal Medicine (Licence: AZ 51454) | |
| 208100000X Physical Medicine & Rehabilitation (Licence: AZ 51454) | |
| 208D00000X General Practice (Licence: AZ 51454) | |
| 224Z00000X Occupational Therapy Assistant | |
| 225100000X Physical Therapist (Licence: AZ 51454) | |
| 225C00000X Rehabilitation Counselor | |
| 225X00000X Occupational Therapist (Licence: AZ 51454) | |
| Enumeration Date | 2012-08-02 |
| Last Update Date | 2023-03-07 |