| NPI | 1659650208 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 50909) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM RP00007709) |
| Enumeration Date | 2011-08-14 |
| Last Update Date | 2022-11-02 |