| NPI | 1477849628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX U3970) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD452334) |
| 207Q00000X Family Medicine (Licence: TX U3970) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: PA MD452334) | |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2024-01-29 |