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 |