| NPI | 1093292112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 64582) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302042794) |
| Enumeration Date | 2018-07-21 |
| Last Update Date | 2021-03-18 |