| NPI | 1639816440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP457341) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 24527) |
| 183700000X Pharmacy Technician (Licence: IA 7072) | |
| Enumeration Date | 2022-05-13 |
| Last Update Date | 2022-11-12 |