Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | 2301010838 | MI |
NPI | 1215583273 |
---|---|
Provider Name | Dr. Marc A Gusse |
First Address | Waterford Township, MI 48329-1171 |
Second Address | Waterford Township, MI 48329-1171 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/08/2019 |
Last Update Date | 15/08/2019 |