| NPI | 1952416323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: TX AP130793) |
| Additional Taxonomies | 111NI0900X Chiropractor, Internist (Licence: TX 10190) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2018-03-01 |