| NPI | 1790226132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 27915) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: CA 70607) |
| Enumeration Date | 2017-03-18 |
| Last Update Date | 2022-04-05 |