| NPI | 1356865562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 60901) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: TX 60901) |
| Enumeration Date | 2017-07-29 |
| Last Update Date | 2023-06-07 |