| 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 |