| NPI | 1558251959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 25325) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302417604) |
| Enumeration Date | 2025-07-07 |
| Last Update Date | 2025-11-21 |