| NPI | 1295415420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 58681) |
| Additional Taxonomies | 1835P0200X Pharmacist, Pediatrics (Licence: TX 58681) |
| Enumeration Date | 2023-07-21 |
| Last Update Date | 2023-07-21 |