| NPI | 1205133204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T9806) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CA 20a14095) |
| Enumeration Date | 2011-02-28 |
| Last Update Date | 2024-10-01 |