| NPI | 1669867461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T1783) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301114204) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX T1783) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: MI 4301114204) | |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: TX T1783) | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2021-06-02 |