| NPI | 1063112688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 30703) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH033548) |
| 183500000X Pharmacist (Licence: LA PST.022861) | |
| 183500000X Pharmacist (Licence: OK 17457) | |
| Enumeration Date | 2023-03-03 |
| Last Update Date | 2023-03-03 |