| NPI | 1477957330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP126475) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 08125) |
| Enumeration Date | 2014-10-21 |
| Last Update Date | 2018-03-17 |