| NPI | 1730809625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH241212) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH PHCY-01390) |
| Enumeration Date | 2022-08-31 |
| Last Update Date | 2025-01-22 |