| NPI | 1568936391 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 32129) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 55829) |
| Enumeration Date | 2019-01-15 |
| Last Update Date | 2021-04-05 |