| NPI | 1114209277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 18816) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202218216) |
| Enumeration Date | 2011-09-15 |
| Last Update Date | 2026-07-22 |