| NPI | 1477140465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 64446) |
| Additional Taxonomies | 251E00000X Home Health |
| 251S00000X Community/Behavioral Health | |
| Enumeration Date | 2020-12-24 |
| Last Update Date | 2020-12-24 |