| NPI | 1558423780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX J5809) |
| Additional Taxonomies | 207QS1201X Family Medicine, Sleep Medicine (Licence: TX J5809) |
| 2083A0300X Preventive Medicine, Addiction Medicine (Licence: TX J5809) | |
| Enumeration Date | 2006-12-14 |
| Last Update Date | 2019-11-18 |