| NPI | 1477359099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: AL 23721) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 76758) |
| Enumeration Date | 2025-02-24 |
| Last Update Date | 2026-02-03 |