| NPI | 1316394471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: NC 23513) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: VA 0202215897) |
| Enumeration Date | 2016-05-18 |
| Last Update Date | 2019-09-11 |