| NPI | 1952307845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP126290) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 6832DC) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2020-07-24 |