| NPI | 1790873552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: AZ 15475) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ 15475) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2021-10-03 |