| NPI | 1518633064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 125604) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN PS62563) |
| Enumeration Date | 2021-08-16 |
| Last Update Date | 2024-01-22 |