| NPI | 1003831967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 777173) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 7111) |
| 363L00000X Nurse Practitioner (Licence: TX 777173) | |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2024-09-13 |