| NPI | 1710003355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: AZ 246065) |
| Additional Taxonomies | 111NS0005X Chiropractor, Sports Physician (Licence: AZ 7556) |
| 111N00000X Chiropractor (Licence: AZ 7556) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2023-02-09 |