| NPI | 1306252127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2014021085) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 0022107) |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2025-12-10 |