| NPI | 1386103190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 261QI0500X Clinic/Center, Infusion Therapy |
| Additional Taxonomies | 3336C0004X Pharmacy, Compounding Pharmacy |
| 1835P1200X Pharmacist, Pharmacotherapy (Licence: OK 18919) | |
| 1835C0207X Pharmacist, Compounded Sterile Preparations (Licence: OK 18919) | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2026-07-23 |