| NPI | 1659399749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 645587) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: TX MT024335) |
| 111N00000X Chiropractor (Licence: TX 8792) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2026-03-20 |