| NPI | 1023695236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 75443) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VT 033.0134165) |
| Enumeration Date | 2021-03-24 |
| Last Update Date | 2026-02-09 |