| NPI | 1083738231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 792698) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 7934) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2013-08-28 |