| NPI | 1073561494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 765935) |
| Additional Taxonomies | 111NX0800X Chiropractor Orthopedic (Licence: TX DC5099) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2023-11-27 |