| NPI | 1497708200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704287416) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: TX DC8263) |
| 111NN0400X Chiropractor, Neurology (Licence: MI 2301009328) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2017-12-07 |