| NPI | 1942452453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363L00000X Nurse Practitioner (Licence: MI 4704370015) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: MI MG009739) |
| Enumeration Date | 2008-10-15 |
| Last Update Date | 2023-10-12 |