| NPI | 1093151086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NC 2016-00166) |
| Additional Taxonomies | 207QS1201X Family Medicine, Sleep Medicine (Licence: NC 2016-00166) |
| Enumeration Date | 2013-05-16 |
| Last Update Date | 2026-02-09 |