| NPI | 1881604395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 1111605) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 6892) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2024-08-08 |