| NPI | 1568462554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QH0002X Family Medicine Hospice and Palliative Medicine (Licence: TX F9338) |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine (Licence: TX F9338) |
| Enumeration Date | 2005-07-31 |
| Last Update Date | 2010-07-13 |