| NPI | 1013716869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: IA 25246) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SD 6048) |
| Enumeration Date | 2025-03-12 |
| Last Update Date | 2025-03-12 |