| NPI | 1720631286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist, Pharmacotherapy (Licence: SC 42620) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: MN 124388) |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2022-03-30 |