| NPI | 1942788393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1300X Pharmacist, Psychiatric (Licence: TX 62899) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 62899) |
| Enumeration Date | 2018-07-29 |
| Last Update Date | 2020-12-15 |