| NPI | 1629267141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX 42258) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AL 28874) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: AL 28874) | |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2013-09-18 |