| NPI | 1316298649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: MN 119826) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 119826) |
| Enumeration Date | 2012-09-26 |
| Last Update Date | 2021-01-08 |