| NPI | 1619437662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2018026767) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: HI 4327) |
| Enumeration Date | 2019-03-24 |
| Last Update Date | 2021-11-07 |