| NPI | 1700245198 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DIRK KANCILIA Director 623-335-1103 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: AZ 8363) |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2016-02-15 |