| NPI | 1831703198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist Ambulatory Care (Licence: UT 7050817-1701) |
| Additional Taxonomies | 163WD0400X Registered Nurse Diabetes Educator (Licence: UT 7050817-1701) |
| Enumeration Date | 2020-09-03 |
| Last Update Date | 2021-04-23 |