| NPI | 1225703077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OK 19248) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 70069) |
| Enumeration Date | 2021-08-13 |
| Last Update Date | 2022-03-09 |