| NPI | 1275019226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835E0208X Pharmacist, Emergency Medicine (Licence: KY 020022) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 020022) |
| Enumeration Date | 2018-07-12 |
| Last Update Date | 2025-07-28 |