| NPI | 1417293135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: TX 29325) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 29325) |
| 183500000X Pharmacist (Licence: NV 10162) | |
| 183500000X Pharmacist (Licence: AK 874) | |
| Enumeration Date | 2012-12-27 |
| Last Update Date | 2020-02-26 |