| NPI | 1114738507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NE 18268) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 0024467) |
| Enumeration Date | 2025-01-15 |
| Last Update Date | 2025-01-15 |