| NPI | 1184067522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS1201X Family Medicine, Sleep Medicine (Licence: VA 0101262761) |
| Additional Taxonomies | 207QS1201X Family Medicine, Sleep Medicine (Licence: LA MD.302465) |
| Enumeration Date | 2013-04-16 |
| Last Update Date | 2019-03-13 |