| NPI | 1548267651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 778736) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 4224) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2020-02-24 |