| NPI | 1124561782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO PHA - 21533) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OK 17025) |
| Enumeration Date | 2016-11-29 |
| Last Update Date | 2026-05-05 |