| NPI | 1821232034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: CT 051199) |
| Additional Taxonomies | 207QS1201X Family Medicine, Sleep Medicine (Licence: CT 051199) |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: CT 51199) | |
| Enumeration Date | 2009-05-01 |
| Last Update Date | 2026-03-18 |