| NPI | 1063850147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207P00000X Emergency Medicine (Licence: OK 29919) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: LA 311630) |
| 207Q00000X Family Medicine (Licence: TX BP10045433) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: OK 29919) | |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: TX BP10045433) | |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2021-04-20 |