| NPI | 1396231080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 122818) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: MN 122818) |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2019-05-08 |