| NPI | 1750636742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX P9195) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: IN 01073054A) |
| Enumeration Date | 2012-07-17 |
| Last Update Date | 2022-07-21 |