| NPI | 1215966031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP125974) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 6932) |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2014-10-21 |