| NPI | 1801889894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX AP129778) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX dc6838) |
| 363L00000X Nurse Practitioner (Licence: TX ap129778) | |
| Enumeration Date | 2005-08-25 |
| Last Update Date | 2023-03-07 |