| NPI | 1447591508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ACN1354) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator |
| 104100000X Social Worker | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PR 15224-I) | |
| Enumeration Date | 2013-03-13 |
| Last Update Date | 2024-03-05 |