| NPI | 1093337693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 20239-40) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302415026) |
| 183500000X Pharmacist (Licence: MN 124365) | |
| 183500000X Pharmacist (Licence: TX 74746) | |
| Enumeration Date | 2020-05-18 |
| Last Update Date | 2025-11-04 |