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 |