| NPI | 1275139743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 68004) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP454715) |
| 183500000X Pharmacist (Licence: CO PHA.0023215) | |
| 183500000X Pharmacist (Licence: WA PH61090511) | |
| Enumeration Date | 2020-12-09 |
| Last Update Date | 2022-07-08 |