| NPI | 1356946081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: TX 68518) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OK 18329) |
| Enumeration Date | 2020-12-01 |
| Last Update Date | 2022-09-15 |