| NPI | 1568836591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: VT 033.0133752) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 54924) |
| Enumeration Date | 2015-11-13 |
| Last Update Date | 2026-08-17 |