| NPI | 1689746190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP132461) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 7177) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2016-11-03 |