| NPI | 1427406404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VT 033.0135327) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA VISN6-STINEHM6351) |
| Enumeration Date | 2016-05-31 |
| Last Update Date | 2026-04-01 |