| NPI | 1578111258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: MO 2019033379) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: OK 18817) |
| Enumeration Date | 2019-08-27 |
| Last Update Date | 2025-07-17 |