| NPI | 1417694506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P10481) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MT PHA-PHA-LIC-117474) |
| 183500000X Pharmacist (Licence: WY 4543) | |
| Enumeration Date | 2022-05-19 |
| Last Update Date | 2026-02-06 |