| NPI | 1750311205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP138161) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 10077) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2019-11-18 |