| NPI | 1356126023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH TT855006) |
| Enumeration Date | 2023-08-30 |
| Last Update Date | 2023-12-08 |