| NPI | 1841229291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 775646) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX DC5982) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2022-08-22 |