NPI | 1811629942 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207QS1201X Family Medicine, Sleep Medicine (Licence: FL UO10409) |
Additional Taxonomies | 207Q00000X Family Medicine (Licence: NV SL1885) |
208D00000X General Practice (Licence: NV DO3835) | |
Enumeration Date | 2022-06-28 |
Last Update Date | 2025-06-18 |