| NPI | 1881953115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: MI 4704317625) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI 2301009928) |
| Enumeration Date | 2012-05-07 |
| Last Update Date | 2021-04-12 |