| NPI | 1396859211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 777944) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX DC7412) |
| 111NN0400X Chiropractor, Neurology (Licence: TX DC7412) | |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2022-04-11 |