| NPI | 1417354564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 121772) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: MN 121772) |
| Enumeration Date | 2014-12-04 |
| Last Update Date | 2025-09-19 |