| NPI | 1972646651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX Q0859) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX 8786) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2017-11-16 |