| NPI | 1851040711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 700560) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: NC 33320) |
| Enumeration Date | 2022-03-19 |
| Last Update Date | 2025-01-30 |