| NPI | 1861596058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL me-81929) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX FTP 45348) |
| 207Q00000X Family Medicine (Licence: GA 66567) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: GA 66567) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: FL ME-81929) | |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX R0996) | |
| 207QH0002X Family Medicine, Hospice and Palliative Medicine (Licence: FL ME81929) | |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2021-04-27 |