| NPI | 1174825459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 48359) |
| Additional Taxonomies | 163WD0400X Registered Nurse, Diabetes Educator (Licence: TX 762621) |
| Enumeration Date | 2010-11-18 |
| Last Update Date | 2021-02-05 |