| NPI | 1003308925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS1201X Family Medicine, Sleep Medicine (Licence: AZ 76780) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: PA MD475299) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2025-06-02 |