| NPI | 1841748704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: TX 65904) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: WA PH60671816) |
| Enumeration Date | 2016-09-20 |
| Last Update Date | 2023-09-22 |