| NPI | 1235340290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX N8039) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0116018184) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2014-03-10 |