| NPI | 1063067320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 20641) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 65160) |
| Enumeration Date | 2019-08-05 |
| Last Update Date | 2022-02-01 |