| NPI | 1700432218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 27393) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2016027739) |
| 183500000X Pharmacist (Licence: SC 41941) | |
| Enumeration Date | 2019-08-12 |
| Last Update Date | 2025-09-25 |