| NPI | 1295858793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 19940) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: MA 19940) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2025-09-11 |