| NPI | 1265879662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 117943) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 42135) |
| Enumeration Date | 2013-05-27 |
| Last Update Date | 2023-08-03 |