| NPI | 1053378588 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 12852) | 
| Additional Taxonomies | 207QS1201X Family Medicine, Sleep Medicine (Licence: SC 12852) | 
| Enumeration Date | 2006-04-27 | 
| Last Update Date | 2020-10-27 |