| NPI | 1376635425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 10955040) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 1142750) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2023-03-07 |