| NPI | 1215152442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX M6862) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: TX M6862) |
| Enumeration Date | 2007-04-14 |
| Last Update Date | 2017-01-09 |