| NPI | 1518411578 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P0200X Pharmacist, Pediatrics (Licence: PA RP450373) |
| Additional Taxonomies | 1835P0200X Pharmacist, Pediatrics (Licence: NC 23627) |
| 1835P0200X Pharmacist, Pediatrics (Licence: VA 0202211832) | |
| Enumeration Date | 2016-08-08 |
| Last Update Date | 2016-08-08 |