| NPI | 1255951992 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MN 78164) |
| Additional Taxonomies | 207QS1201X Family Medicine, Sleep Medicine (Licence: MN 78164) |
| Enumeration Date | 2020-04-22 |
| Last Update Date | 2024-12-05 |