| NPI | 1740166016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: NC 31272) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: NC 700599) |
| Enumeration Date | 2025-08-13 |
| Last Update Date | 2025-08-13 |