| NPI | 1740897867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 67054) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: AZ S025336) |
| Enumeration Date | 2020-09-24 |
| Last Update Date | 2022-07-18 |