| NPI | 1215310776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA PH60764821) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 060413-1) |
| 1835P2201X Pharmacist, Ambulatory Care (Licence: CO 0021305) | |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2022-07-21 |