| NPI | 1124360987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA12028) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 12366) |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2025-06-05 |