| NPI | 1629399712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: MI 5302037270) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302037270) |
| Enumeration Date | 2010-06-12 |
| Last Update Date | 2021-12-02 |