| NPI | 1770123408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302412192) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 66579) |
| Enumeration Date | 2020-01-10 |
| Last Update Date | 2022-04-09 |