| NPI | 1609474493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P0200X Pharmacist, Pediatrics (Licence: TX 68511) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2020028369) |
| Enumeration Date | 2020-10-13 |
| Last Update Date | 2022-12-28 |