Individual
LIAM VAN SAMELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
CORNER OF ROUTE N12 AND N7, FORT DEFIANCE, AZ 86504-0649
(928) 729-8000
Mailing address
PO BOX 649, FORT DEFIANCE, AZ 86504-0649
(602) 635-0582
Taxonomy
Speciality
Code
Description
License number
State
227900000X
Registered Respiratory Therapist
Primary
044850
AZ
Other
Enumeration date
03/18/2022
Last updated
03/18/2022
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