| NPI | 1699356295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: TX 68394) |
| Additional Taxonomies | 3336C0002X Pharmacy, Clinic Pharmacy (Licence: TX 68394) |
| Enumeration Date | 2021-04-16 |
| Last Update Date | 2022-01-28 |