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 |