| NPI | 1407528797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2012024155) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: KS 1-10688) |
| Enumeration Date | 2021-10-04 |
| Last Update Date | 2021-10-04 |