| NPI | 1619118502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2010030706) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 119357) |
| 1835P2201X Pharmacist, Ambulatory Care (Licence: DC 6150007) | |
| Enumeration Date | 2009-03-23 |
| Last Update Date | 2021-01-07 |