| NPI | 1831657980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P0200X Pharmacist, Pediatrics (Licence: TN 35602) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: SC 11881) |
| Enumeration Date | 2019-03-07 |
| Last Update Date | 2022-01-18 |