| NPI | 1144730839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: TX 64534) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS56773) |
| Enumeration Date | 2017-10-07 |
| Last Update Date | 2023-01-03 |