| NPI | 1992792881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QG0300X Family Medicine, Geriatric Medicine (Licence: TX P9312) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: TX P9312) |
| 207Q00000X Family Medicine (Licence: IA 22136) | |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2021-04-12 |