| NPI | 1407088966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: WV 27242) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: TX Q2033) |
| Enumeration Date | 2009-08-18 |
| Last Update Date | 2022-04-15 |