| NPI | 1396708749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 777658) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 6644) |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2015-11-24 |