| NPI | 1063025567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 63319) |
| Additional Taxonomies | 1835P1200X Pharmacist, Pharmacotherapy (Licence: TX 63319) |
| Enumeration Date | 2020-08-25 |
| Last Update Date | 2022-02-05 |