| NPI | 1700266988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: VA 0116028046) |
| Additional Taxonomies | 207QS1201X Family Medicine, Sleep Medicine (Licence: VA 0101262244) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2023-04-05 |