| NPI | 1902897234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX 774755) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 8248) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2012-08-15 |