| NPI | 1295745289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty (Licence: TX H7262) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX H7262) |
| 2084P0805X (Licence: TX H7262) | |
| 207Q00000X Family Medicine (Licence: TX H7262) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2026-02-18 |