| NPI | 1568458867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX J9517) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX J9517) |
| 2083P0011X Preventive Medicine, Undersea and Hyperbaric Medicine (Licence: TX J9517) | |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2023-05-22 |