| NPI | 1366735995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 8255) |
| Additional Taxonomies | 1835P1200X Pharmacist Pharmacotherapy (Licence: OR 8255) |
| Enumeration Date | 2011-05-16 |
| Last Update Date | 2022-10-28 |