| NPI | 1922603612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 63736) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: TX 63736) |
| Enumeration Date | 2020-12-01 |
| Last Update Date | 2020-12-01 |