| NPI | 1225362585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX N3639) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX N3639) |
| Enumeration Date | 2009-09-18 |
| Last Update Date | 2022-07-21 |