| NPI | 1821110545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP131563) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 7233) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2021-06-06 |