| NPI | 1609478445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: TX 56974) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: TX 56974) |
| Enumeration Date | 2020-11-16 |
| Last Update Date | 2020-11-16 |