Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | 1149199 | AZ |
NPI | 1134785967 |
---|---|
Provider Name | Dylan Irish |
First Address | Scottsdale, AZ 85255-4153 |
Second Address | Mesa, AZ 85206-3628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2019 |
Last Update Date | 14/01/2021 |