| NPI | 1881779502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q9601) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 8765) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2018-06-29 |