| NPI | 1366615866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 782638) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10849) |
| Enumeration Date | 2008-04-07 |
| Last Update Date | 2016-11-15 |