| NPI | 1477961969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P6597) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 013616) |
| Enumeration Date | 2014-07-28 |
| Last Update Date | 2023-03-25 |