| NPI | 1629101357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ AP4379) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 3904) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2012-11-19 |