| NPI | 1447834650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: TX 58412) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 58412) |
| Enumeration Date | 2021-05-12 |
| Last Update Date | 2022-10-07 |