| NPI | 1407406028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WA 60937049) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 22882) |
| 183500000X Pharmacist (Licence: CA 91783) | |
| Enumeration Date | 2019-09-16 |
| Last Update Date | 2026-08-14 |