| NPI | 1649384280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX H0991) |
| Additional Taxonomies | 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: TX H0991) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX H0991) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2015-11-24 |