| NPI | 1013326164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: WI 17605-40) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S021030) |
| 183500000X Pharmacist (Licence: MI 5302044879) | |
| Enumeration Date | 2014-08-02 |
| Last Update Date | 2026-05-02 |