| NPI | 1780357509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 28530) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS62764) |
| Enumeration Date | 2021-07-28 |
| Last Update Date | 2023-09-13 |