| NPI | 1629661756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835G0303X Pharmacist, Geriatric (Licence: MN 113791) |
| Additional Taxonomies | 1835G0303X Pharmacist, Geriatric (Licence: WI 12979) |
| Enumeration Date | 2021-02-19 |
| Last Update Date | 2021-02-19 |