| NPI | 1407162910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 117769) |
| Additional Taxonomies | 1835P2201X Pharmacist Ambulatory Care (Licence: MN 117769) |
| Enumeration Date | 2010-08-20 |
| Last Update Date | 2021-08-04 |