| NPI | 1184600546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: SC 009110) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: TX 44945) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2026-01-16 |