| NPI | 1831561406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 122540) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: MN 122540) |
| Enumeration Date | 2015-10-22 |
| Last Update Date | 2022-04-06 |