| NPI | 1255751798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 282N00000X General Acute Care Hospital (Licence: TX 25069) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 44229) |
| Enumeration Date | 2014-04-23 |
| Last Update Date | 2024-02-08 |