| NPI | 1720832439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 69941) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-103640) |
| Enumeration Date | 2024-04-17 |
| Last Update Date | 2024-04-17 |