| NPI | 1013375765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: VA 0202207839) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: MA 707155) |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2016-02-09 |