| NPI | 1417411604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: FL PS58827) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS58827) |
| Enumeration Date | 2019-01-22 |
| Last Update Date | 2021-01-28 |