| NPI | 1912404807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207QS1201X Family Medicine, Sleep Medicine (Licence: MI 5101026708) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: MI 5101026708) |
| 207R00000X Internal Medicine (Licence: OH 34.014957) | |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2022-06-28 |