| NPI | 1770226664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: TX 69138) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: NC 30714) |
| Enumeration Date | 2022-04-18 |
| Last Update Date | 2022-04-19 |