| NPI | 1063189140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 022244) |
| Additional Taxonomies | 1835C0207X Pharmacist, Compounded Sterile Preparations (Licence: KY 022244) |
| Enumeration Date | 2021-08-25 |
| Last Update Date | 2024-11-08 |