| NPI | 1194918730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: VA 0202212861) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 26186) |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2016-01-28 |