| NPI | 1619565926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 20087) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 68068) |
| Enumeration Date | 2021-01-04 |
| Last Update Date | 2022-09-02 |