| NPI | 1104523778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 16903) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 11221) |
| Enumeration Date | 2023-02-14 |
| Last Update Date | 2023-02-14 |