| NPI | 1457452856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP10952) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 5513) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2020-03-31 |