| NPI | 1598544520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP459816) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DE A1-0015960) |
| 183500000X Pharmacist (Licence: CO PHA.0025458) | |
| Enumeration Date | 2023-09-28 |
| Last Update Date | 2026-01-29 |