| NPI | 1407982135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP129266) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 6478) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2022-11-17 |