| NPI | 1114117132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP121587) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX DC5105) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX 781910) | |
| Enumeration Date | 2007-07-26 |
| Last Update Date | 2020-10-18 |