| NPI | 1962943209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA 031193) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 020298) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2017-03-20 |
| Last Update Date | 2022-06-28 |