| NPI | 1427370782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP8147) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 8119) |
| 208VP0000X Pain Medicine, Pain Medicine (Licence: AZ AP8147) | |
| Enumeration Date | 2010-02-26 |
| Last Update Date | 2023-07-20 |