| NPI | 1023750882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PR 8075) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: PR 2985) |
| Enumeration Date | 2022-04-12 |
| Last Update Date | 2023-05-28 |