| NPI | 1235129370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: OK 9795) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX E1498) |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2016-12-21 |