| NPI | 1225766512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AZ 15233) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 17359) |
| Enumeration Date | 2022-08-12 |
| Last Update Date | 2022-08-12 |