| NPI | 1790998706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX K9751) |
| Additional Taxonomies | 207QG0300X Family Medicine Geriatric Medicine (Licence: TX K9751) |
| Enumeration Date | 2007-05-07 |
| Last Update Date | 2023-11-09 |