| NPI | 1497350755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2016027161) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-100053) |
| Enumeration Date | 2020-12-03 |
| Last Update Date | 2026-07-12 |