| NPI | 1104864982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP120452) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 6768) |
| 363L00000X Nurse Practitioner (Licence: TX F0611348) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2020-03-11 |