| NPI | 1780303941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WI 21503) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH241011) |
| Enumeration Date | 2022-08-23 |
| Last Update Date | 2024-06-21 |