| NPI | 1720284920 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JORDAN S ROSS Rendering Provider 480-686-9686 |
| Organization Subpart ? | No |
| Primary Taxonomy | 204D00000X Neuromusculoskeletal Medicine & OMM (Licence: AZ 3119) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ 3119) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2020-08-22 |