| NPI | 1881985760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX P6201) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA 20A11649) |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2013-10-10 |