| NPI | 1235244971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 1046352) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10059) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2021-09-28 |