| NPI | 1073500955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX 776723) |
| Additional Taxonomies | 111NN0400X Chiropractor, Neurology (Licence: TX 6779) |
| 111NR0200X Chiropractor, Radiology (Licence: TX 6779) | |
| 111NX0100X Chiropractor, Occupational Health (Licence: TX 6779) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 776723) | |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2016-02-12 |