| NPI | 1952834442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835P2201X Pharmacist, Ambulatory Care (Licence: AZ S22165) |
| Additional Taxonomies | 1835P2201X Pharmacist, Ambulatory Care (Licence: NC 26170) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2017-04-11 |