| NPI | 1134647266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: AZ S023025) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 60690) |
| Enumeration Date | 2017-09-09 |
| Last Update Date | 2021-10-04 |