| NPI | 1083068654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 36579) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NY 062444) |
| 183500000X Pharmacist (Licence: AZ S023876) | |
| 183500000X Pharmacist (Licence: TX 65479) | |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2023-08-02 |