| NPI | 1164014353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL 30682) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA 020244) |
| 183500000X Pharmacist (Licence: TX 68145) | |
| 183500000X Pharmacist (Licence: HI 4445) | |
| Enumeration Date | 2021-02-09 |
| Last Update Date | 2021-07-28 |