| NPI | 1629630488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist Ambulatory Care (Licence: MN 124294) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 124294) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2021-09-01 |