| NPI | 1053080010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 71341) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: TX 187365) |
| Enumeration Date | 2021-09-12 |
| Last Update Date | 2022-09-16 |