| NPI | 1366421729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: UT 168632-1205) |
| Additional Taxonomies | 207QA0401X Family Medicine, Addiction Medicine (Licence: UT 168632-1205) |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: UT 168632-1205) | |
| 207QS1201X Family Medicine, Sleep Medicine (Licence: UT 168632-1205) | |
| 207Q00000X Family Medicine (Licence: UT 168632-1205) | |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2015-02-27 |