| NPI | 1235104399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CA A79378) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: CA a79378) |
| 174400000X Specialist (Licence: CA a79378) | |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2016-08-08 |