| NPI | 1982728853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX T5803) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: AR E-4054) |
| Enumeration Date | 2007-03-18 |
| Last Update Date | 2022-03-24 |