| NPI | 1144958323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: CO 0024529) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 75912) |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2026-09-03 |