| NPI | 1083407258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 023607) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: KY 023607) |
| Enumeration Date | 2025-05-28 |
| Last Update Date | 2025-06-24 |