| NPI | 1205803780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MI 5601003439) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301006527) |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2026-08-11 |