| NPI | 1255948345 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VA 0202219611) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 29807) |
| Enumeration Date | 2020-09-23 |
| Last Update Date | 2022-10-21 |