| NPI | 1245868264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T8573) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: TX T8573) |
| 207QS1201X Family Medicine, Sleep Medicine (Licence: TX T8573) | |
| Enumeration Date | 2020-03-27 |
| Last Update Date | 2023-10-09 |