| NPI | 1518020304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 171M00000X Case Manager/Care Coordinator (Licence: CA c42535) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: CA C42535) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2007-07-08 |