NPI | 1205327392 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS1201X Family Medicine, Sleep Medicine (Licence: FL ME156292) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: IA R-11139) |
Enumeration Date | 2018-05-23 |
Last Update Date | 2022-06-20 |