| NPI | 1578848917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 56319) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH024978) |
| 183500000X Pharmacist (Licence: TN 0000034283) | |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2023-01-12 |