| NPI | 1104074756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 013529) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL Ps54710) |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2025-01-21 |