| NPI | 1174831739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP123945) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11514) |
| 363L00000X Nurse Practitioner (Licence: TX F0613830) | |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP123945) | |
| Enumeration Date | 2010-09-16 |
| Last Update Date | 2022-08-04 |