| NPI | 1750389003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP136899) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX DC6524) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2018-04-25 |