| NPI | 1346585346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: UT 4744751-1204) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S019096) |
| Enumeration Date | 2012-12-01 |
| Last Update Date | 2017-11-22 |