| NPI | 1659268878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID 4771352) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 023684) |
| Enumeration Date | 2025-06-20 |
| Last Update Date | 2025-06-20 |