| NPI | 1619264397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: UT 10074148-1204) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 10074148-1204) |
| 207Q00000X Family Medicine (Licence: CA 20A12688) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: UT 10074148-1204) | |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2021-10-06 |