| NPI | 1770760944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0101241509) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX V2156) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: MD D70693) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX V2156) | |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2024-09-30 |