| NPI | 1114951480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX F5818) |
| Additional Taxonomies | 146D00000X Personal Emergency Response Attendant (Licence: TX F5818) |
| 207QG0300X Family Medicine Geriatric Medicine (Licence: TX F5818) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2009-12-09 |