| NPI | 1093224842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WY 4003) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P7820) |
| Enumeration Date | 2017-09-25 |
| Last Update Date | 2022-06-05 |