| NPI | 1972678126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: TX 3049) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: TX AP120415) |
| 363LF0000X Nurse Practitioner, Family (Licence: TX AP120415) | |
| 111NN1001X Chiropractor, Nutrition (Licence: TX 3049) | |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2018-03-20 |