| NPI | 1700073467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 9600) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: TX AP132618) |
| Enumeration Date | 2007-09-26 |
| Last Update Date | 2020-06-02 |