| NPI | 1134464258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH232523) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 48225) |
| Enumeration Date | 2012-11-29 |
| Last Update Date | 2023-10-10 |