| NPI | 1265915284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: TX 73727) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 73727) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-09-14 |
| Last Update Date | 2025-03-14 |