| NPI | 1376575753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: TX 43602) |
| Additional Taxonomies | 146L00000X Emergency Medical Technician, Paramedic (Licence: TX 8141) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2021-03-25 |