| NPI | 1316206691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS1201X Family Medicine, Sleep Medicine (Licence: KS 04-39317) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 4301100415) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MI 4301100415) | |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2016-08-17 |