| NPI | 1184735995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: WI 2331-23) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 3864) |
| 363A00000X Physician Assistant (Licence: MI 5601005499) | |
| 111N00000X Chiropractor (Licence: MI 2301009563) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2021-09-21 |