| NPI | 1417130659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: TX PA05458) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 9454) |
| Enumeration Date | 2007-12-11 |
| Last Update Date | 2023-03-23 |