| NPI | 1811933096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 71422) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CO RN174865) |
| 163W00000X Registered Nurse (Licence: SC 71422) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2021-03-11 |