| NPI | 1710040761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 774434) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 6383) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2019-12-10 |