| NPI | 1245352756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP128914) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 9319) |
| 111NR0400X Chiropractor Rehabilitation (Licence: TX 9319) | |
| 111NS0005X Chiropractor Sports Physician (Licence: TX 9319) | |
| 363L00000X Nurse Practitioner (Licence: TX AP128914) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2023-08-31 |