| NPI | 1164944658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P0200X Pharmacist, Pediatrics (Licence: OK 17518) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: OK 17518) |
| 1835P2201X Pharmacist, Ambulatory Care (Licence: OK 17518) | |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2017-07-17 |