| NPI | 1790227049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: MD 20223) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: VA 0202210802) |
| Enumeration Date | 2016-11-16 |
| Last Update Date | 2016-11-16 |