| NPI | 1154521086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP129709) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: ID CHIA 1256) |
| 111N00000X Chiropractor (Licence: OR 3999) | |
| 363LF0000X Nurse Practitioner, Family (Licence: OR 201392422NP-PP) | |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2017-07-07 |