| NPI | 1013925130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP144579) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 9318) |
| 225100000X Physical Therapist (Licence: TX 1169100) | |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2021-08-17 |