| NPI | 1053754358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS1201X Family Medicine, Sleep Medicine (Licence: VA 0101258584) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101258584) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2026-01-30 |