| NPI | 1740976299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: SC 97804) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2025-00721) |
| 207QS1201X Family Medicine, Sleep Medicine (Licence: SC 97804) | |
| Enumeration Date | 2023-04-17 |
| Last Update Date | 2026-07-31 |