| NPI | 1316420326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 70546) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: TX 70546) |
| Enumeration Date | 2018-09-14 |
| Last Update Date | 2026-08-13 |