| NPI | 1346375383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP134332) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10209) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2024-07-26 |