| NPI | 1457957490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 26296) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202217489) |
| Enumeration Date | 2020-12-06 |
| Last Update Date | 2021-10-07 |