| NPI | 1497389084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 30284) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 20687) |
| 183500000X Pharmacist (Licence: WI 18168-40) | |
| Enumeration Date | 2020-02-24 |
| Last Update Date | 2026-02-05 |