| NPI | 1407061732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist Ambulatory Care (Licence: NC 07858) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 7858) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2020-05-14 |