NPI | 1881649945 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 363LF0000X Nurse Practitioner Family (Licence: TX 778319) |
Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 4546) |
Enumeration Date | 2006-05-24 |
Last Update Date | 2012-06-19 |