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 |