| NPI | 1508299165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2022031307) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-16097) |
| 183500000X Pharmacist (Licence: NC 26736) | |
| Enumeration Date | 2013-08-18 |
| Last Update Date | 2022-08-30 |