| NPI | 1033762828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP142258) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: TX AC01677) |
| Enumeration Date | 2019-07-20 |
| Last Update Date | 2019-07-20 |