| NPI | 1821217969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 55996) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: TX Pending) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2021-05-03 |