| NPI | 1639805518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: MI 5302415284) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302415284) |
| Enumeration Date | 2022-07-25 |
| Last Update Date | 2026-03-16 |