| NPI | 1750794822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 1088172) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 12108) |
| Enumeration Date | 2014-06-06 |
| Last Update Date | 2024-09-28 |