| NPI | 1760459804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: NV 20109) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ 10813) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2025-03-21 |