| NPI | 1992092282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 35.125965) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX V0474) |
| 207QG0300X Family Medicine, Geriatric Medicine (Licence: OH 35.125965) | |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2025-06-09 |