| NPI | 1790073344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1835C0207X Pharmacist, Compounded Sterile Preparations (Licence: PA RP455274) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 21976) |
| 183500000X Pharmacist (Licence: SC 13382) | |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2025-07-03 |