| NPI | 1407488117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 69238) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: LA pst.023306) |
| Enumeration Date | 2020-02-11 |
| Last Update Date | 2025-03-22 |