| NPI | 1487831129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP5190) |
| Additional Taxonomies | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: AZ AP5190) |
| 111N00000X Chiropractor (Licence: UT 6858781-1202) | |
| Enumeration Date | 2008-01-24 |
| Last Update Date | 2022-03-11 |