| NPI | 1497855746 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX AP120530) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 9387) |
| 364SF0001X Clinical Nurse Specialist Family Health (Licence: TX 775075) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2017-05-10 |