| NPI | 1194098111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R1649) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-13931) |
| Enumeration Date | 2012-02-22 |
| Last Update Date | 2019-03-25 |