| NPI | 1558724542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: IA 17785) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: CA 46164) |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2016-03-29 |