| NPI | 1982010203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207QS1201X Family Medicine, Sleep Medicine (Licence: TX S3791) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: AZ R74531) |
| 207QS1201X Family Medicine, Sleep Medicine (Licence: AZ 55355) | |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2020-11-30 |