| NPI | 1104539378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 36428) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 13497) |
| 183500000X Pharmacist (Licence: NV 20999) | |
| Enumeration Date | 2023-01-03 |
| Last Update Date | 2023-01-03 |