| NPI | 1881197713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: MO 2013031924) |
| Additional Taxonomies | 1835C0205X Pharmacist, Critical Care (Licence: MO 2013031924) |
| Enumeration Date | 2018-03-16 |
| Last Update Date | 2026-03-20 |