| NPI | 1255513107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: UT 7387085-4405) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: UT 7387085-1202) |
| Enumeration Date | 2007-12-03 |
| Last Update Date | 2022-06-22 |