| NPI | 1225856552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 6482080-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 21103) |
| Enumeration Date | 2024-09-26 |
| Last Update Date | 2024-09-26 |