| NPI | 1285263541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 14190424-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OK 18640) |
| Enumeration Date | 2020-04-07 |
| Last Update Date | 2025-02-07 |