| NPI | 1104493485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QS1200X Clinic/Center, Sleep Disorder Diagnostic |
| Additional Taxonomies | 156F00000X Technician/Technologist (Licence: CA PTGL296) |
| 251E00000X Home Health | |
| Enumeration Date | 2021-06-07 |
| Last Update Date | 2021-08-25 |