| NPI | 1851915979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: TX 66448) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 66448) |
| 183500000X Pharmacist (Licence: OR 0017394) | |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2021-08-19 |