| NPI | 1700986494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP125233) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX DC6904) |
| Enumeration Date | 2006-09-23 |
| Last Update Date | 2026-06-11 |