| NPI | 1568130177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 70127) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WA 61178472) |
| Enumeration Date | 2021-08-31 |
| Last Update Date | 2024-08-30 |