| NPI | 1538380399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D009455) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P5982) |
| 183500000X Pharmacist (Licence: AZ S018481) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2023-03-01 |