| NPI | 1346933512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4351051020) |
| Enumeration Date | 2023-06-01 |
| Last Update Date | 2024-02-19 |