NPI | 1609335751 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207QS1201X Family Medicine, Sleep Medicine (Licence: GA 96776) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: UT 11839039-1205) |
Enumeration Date | 2019-03-18 |
Last Update Date | 2023-10-31 |