| NPI | 1104201847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist Ambulatory Care (Licence: PA RP449639) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP449639) |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2024-02-15 |