| NPI | 1790958999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor Rehabilitation (Licence: TX 9913) |
| Additional Taxonomies | 172A00000X Driver |
| 171W00000X Contractor | |
| Enumeration Date | 2008-04-08 |
| Last Update Date | 2016-01-25 |