| NPI | 1295289700 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA RPH029342)  | 
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ s023580)  | 
| Enumeration Date | 2016-08-12 | 
| Last Update Date | 2021-11-30 |