| NPI | 1902429376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: NC 700355) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 29373) |
| Enumeration Date | 2020-05-20 |
| Last Update Date | 2022-10-07 |