| NPI | 1679899579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NV 18147) |
| Additional Taxonomies | 207QS1201X Family Medicine, Sleep Medicine (Licence: MN 54687) |
| 2083X0100X Preventive Medicine, Occupational Medicine (Licence: MN 54687) | |
| Enumeration Date | 2010-04-16 |
| Last Update Date | 2026-03-18 |