| NPI | 1730478918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: LA 019262) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 49655) |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2026-06-16 |