| NPI | 1801057260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 45446) |
| Additional Taxonomies | 174H00000X Health Educator |
| 183500000X Pharmacist (Licence: NM RP00007066) | |
| 183500000X Pharmacist (Licence: AZ S017078) | |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2020-02-02 |