| NPI | 1114159142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 776968) |
| Additional Taxonomies | 111NX0800X Chiropractor, Orthopedic (Licence: TX 11230) |
| Enumeration Date | 2009-08-08 |
| Last Update Date | 2013-08-01 |