| NPI | 1073519690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 20544) |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine (Licence: NC 20544) |
| 207QS1201X Family Medicine, Sleep Medicine (Licence: NC 20544) | |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2025-06-11 |