| NPI | 1679161319 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: CA 83998) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: HI 4534) |
| Enumeration Date | 2021-01-07 |
| Last Update Date | 2024-04-02 |