| NPI | 1104543743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: TX 71205) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 71205) |
| Enumeration Date | 2022-10-25 |
| Last Update Date | 2023-07-31 |