NPI | 1083173405 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL TRN42496) |
Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: FL CBHCM102175-P) |
Enumeration Date | 2019-03-15 |
Last Update Date | 2025-06-04 |