| NPI | 1124013552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M6981) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX M6981) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2011-06-02 |