| NPI | 1083915953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: CA 95008811) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11461) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP126697) | |
| Enumeration Date | 2010-11-09 |
| Last Update Date | 2018-07-13 |