| NPI | 1154568558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX P1646) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: TX P1646) |
| Enumeration Date | 2009-01-07 |
| Last Update Date | 2018-09-20 |