| NPI | 1154736239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX U1580) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TN 54916) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: TX U1580) | |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2026-03-06 |