| NPI | 1649716622 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1027316) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10803) |
| 163W00000X Registered Nurse (Licence: TX 897673) | |
| Enumeration Date | 2017-01-13 |
| Last Update Date | 2023-12-18 |