| NPI | 1417287046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP128486) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11339) |
| Enumeration Date | 2010-01-04 |
| Last Update Date | 2024-10-03 |