| NPI | 1962766642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: TX 44958) |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: GA 71399) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2016-04-19 |