| NPI | 1083141881 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist Ambulatory Care (Licence: AZ S025038) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 0020843) |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2024-07-30 |