| NPI | 1104239177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 22124-40) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 19717) |
| 183500000X Pharmacist (Licence: MN 120754) | |
| Enumeration Date | 2014-06-08 |
| Last Update Date | 2026-03-27 |