| NPI | 1861056418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P1200X Pharmacist Pharmacotherapy (Licence: NC 17339) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: MA E0912401) |
| Enumeration Date | 2019-04-30 |
| Last Update Date | 2019-04-30 |