| NPI | 1265028450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: OR 0018460) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 0023306) |
| Enumeration Date | 2020-12-12 |
| Last Update Date | 2022-03-25 |