| NPI | 1689683088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PR 6928) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: PR 2796) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2021-11-15 |