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 |