| NPI | 1952789893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: VA 0202214049) |
| Additional Taxonomies | 1835P0200X Pharmacist, Pediatrics (Licence: VA 0202214049) |
| Enumeration Date | 2015-05-12 |
| Last Update Date | 2016-07-05 |