| NPI | 1780048264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS1201X Family Medicine, Sleep Medicine (Licence: VA 0101283107) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: VA 0101283107) |
| 207Q00000X Family Medicine (Licence: OH 35.139042) | |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2026-02-23 |