| NPI | 1699379610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CT PCT14660) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CA RPH83390) |
| 183500000X Pharmacist (Licence: MA PH28810) | |
| Enumeration Date | 2020-11-30 |
| Last Update Date | 2022-08-19 |