| NPI | 1407159544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP130832) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10365) |
| 111N00000X Chiropractor (Licence: FL 5853) | |
| 111N00000X Chiropractor (Licence: NC 1660) | |
| Enumeration Date | 2010-12-13 |
| Last Update Date | 2017-02-09 |