| NPI | 1821497355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: MN 121318) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 121318) |
| Enumeration Date | 2014-08-20 |
| Last Update Date | 2026-09-10 |