| NPI | 1801505722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: OK 19819) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: TX 70905) |
| Enumeration Date | 2022-11-18 |
| Last Update Date | 2023-07-07 |