| NPI | 1124403027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: WI 75767) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 18058) |
| Enumeration Date | 2015-07-21 |
| Last Update Date | 2023-07-11 |