| NPI | 1639492945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: TX AP125975) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11344) |
| Enumeration Date | 2010-03-02 |
| Last Update Date | 2014-11-17 |