| NPI | 1336729904 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS1201X Family Medicine Sleep Medicine (Licence: MI 4301511521) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2024-09-24 |