| NPI | 1306341326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC RTL26-0234) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 67442) |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2026-06-23 |