| NPI | 1689860421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL ME127807) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PR 17055) |
| 207Q00000X Family Medicine (Licence: TX N5844) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME127807) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX N5844) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: PR 17055) | |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: FL ME127807) | |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: TX N5844) | |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: PR 17055) | |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2018-08-09 |