| NPI | 1912121583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: AZ AP8327) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: AZ 3914) |
| 111N00000X Chiropractor (Licence: NM 1558) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2015-12-12 |