| NPI | 1083020200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: DC PH100001742) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 22389) |
| 183500000X Pharmacist (Licence: VA 0202212951) | |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2022-04-28 |