| NPI | 1629906151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00007988) |
| Additional Taxonomies | 1835P0200X Pharmacist, Pediatrics (Licence: NM 8150894) |
| Enumeration Date | 2026-05-13 |
| Last Update Date | 2026-05-13 |