| NPI | 1194074799 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 0011793)  | 
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0011793)  | 
| Enumeration Date | 2012-08-29 | 
| Last Update Date | 2024-03-04 |