| NPI | 1033626551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: AZ s023012) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: CA 80158) |
| Enumeration Date | 2018-01-05 |
| Last Update Date | 2024-03-02 |