| NPI | 1255980660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: KY 020817) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: IN 26028360A) |
| Enumeration Date | 2019-09-09 |
| Last Update Date | 2024-01-25 |