| NPI | 1659762755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LA2100X Nurse Practitioner, Acute Care (Licence: TX 1025594) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 11449) |
| Enumeration Date | 2015-02-10 |
| Last Update Date | 2021-07-20 |