| NPI | 1699302737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS1201X Family Medicine, Sleep Medicine (Licence: NC 2025-01714) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: GA 12176) |
| 207Q00000X Family Medicine (Licence: GA 93826) | |
| 207Q00000X Family Medicine (Licence: NC 2025-01714) | |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2025-07-15 |