| NPI | 1710419783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS1201X Family Medicine, Sleep Medicine (Licence: MI 5101023082) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101023082) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2025-04-22 |