| NPI | 1780109090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: OR 0016737) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 8689261-1701) |
| Enumeration Date | 2017-08-08 |
| Last Update Date | 2020-03-25 |