Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101020970 | MI |
NPI | 1245645282 |
---|---|
Provider Name | David Robert Hickling |
First Address | Clinton Twp, MI 48035-2958 |
Second Address | Clinton Twp, MI 48035-2958 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2014 |
Last Update Date | 24/11/2021 |