| 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 |