| NPI | 1881936003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: TX T7383) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OK 15383) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2026-06-11 |