| NPI | 1902086937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX N3416) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX N3416) |
| Enumeration Date | 2007-11-07 |
| Last Update Date | 2024-05-28 |