| NPI | 1760855704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: TX 28458) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: AL 10403) |
| Enumeration Date | 2015-11-12 |
| Last Update Date | 2015-11-12 |