| NPI | 1356168074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CA 90235) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 74871) |
| Enumeration Date | 2024-09-24 |
| Last Update Date | 2024-10-22 |