| NPI | 1306089115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP125373) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11151) |
| Enumeration Date | 2009-04-08 |
| Last Update Date | 2020-12-10 |