| NPI | 1851896963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P1300X Pharmacist, Psychiatric (Licence: TX 66994) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 66994) |
| Enumeration Date | 2018-03-29 |
| Last Update Date | 2023-04-20 |