| NPI | 1174086847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: TN 72141) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH032613) |
| 183500000X Pharmacist (Licence: AL 20432) | |
| Enumeration Date | 2019-04-10 |
| Last Update Date | 2024-04-09 |