| NPI | 1710562806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 60449) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA ph236710) |
| Enumeration Date | 2021-03-10 |
| Last Update Date | 2021-03-10 |