| NPI | 1417213877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: AR e19687) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL ps43909) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| 183500000X Pharmacist (Licence: MD ps43909) | |
| Enumeration Date | 2012-04-10 |
| Last Update Date | 2025-08-07 |