| NPI | 1316457104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: OR 0016296) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 0016296) |
| Enumeration Date | 2017-10-05 |
| Last Update Date | 2019-12-17 |