| NPI | 1073524971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX D2464) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX D2464) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX D2464) | |
| Enumeration Date | 2006-08-10 |
| Last Update Date | 2008-01-08 |