| NPI | 1578049763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS1201X Family Medicine, Sleep Medicine (Licence: WI 77190-20) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: IL 125.073406) |
| Enumeration Date | 2018-07-11 |
| Last Update Date | 2022-08-03 |