| NPI | 1598365587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2018014091) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 61501) |
| Enumeration Date | 2020-10-28 |
| Last Update Date | 2022-12-19 |