| NPI | 1144243890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M6548) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NM MD2020-0302) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX M6548) | |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2023-10-18 |