| NPI | 1164560090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LX0106X Nurse Practitioner, Occupational Health (Licence: TX 1058907) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX DC8572) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2022-05-17 |