| NPI | 1487192258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: ND 5698) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ND 5698) |
| Enumeration Date | 2017-02-01 |
| Last Update Date | 2017-02-01 |