| NPI | 1194730499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP120380) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX DC 7894) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2020-04-09 |