| NPI | 1801373022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: UT 10471829-1721) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MT PHA-PHA-LIC-54918) |
| Enumeration Date | 2018-07-20 |
| Last Update Date | 2020-08-03 |