| NPI | 1366052185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist Ambulatory Care (Licence: TX 67097) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 23934) |
| Enumeration Date | 2020-08-06 |
| Last Update Date | 2024-10-21 |