| NPI | 1437357472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP136499) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: NM CNP-02934) |
| 111N00000X Chiropractor (Licence: AZ 7718) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2024-02-13 |