| NPI | 1316042849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX J9781) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX J9781) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX J9781) | |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2020-09-04 |