| NPI | 1366405029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: CO 43687) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX G1754) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2016-09-14 |