| NPI | 1023306768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2011027337) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 21467) |
| Enumeration Date | 2011-07-15 |
| Last Update Date | 2025-09-02 |