| NPI | 1275294084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 122785) |
| Additional Taxonomies | 1835G0303X Pharmacist Geriatric (Licence: MN 122785) |
| 1835P1200X Pharmacist Pharmacotherapy (Licence: MN 122785) | |
| 3336C0003X Pharmacy Community/Retail Pharmacy (Licence: MN 122785) | |
| Enumeration Date | 2022-01-04 |
| Last Update Date | 2022-01-04 |