| NPI | 1215554811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 13867747-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P8844) |
| Enumeration Date | 2020-06-29 |
| Last Update Date | 2025-09-29 |