| NPI | 1790184455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 22424) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202212991) |
| 183500000X Pharmacist (Licence: DC PH100002024) | |
| Enumeration Date | 2014-08-19 |
| Last Update Date | 2021-09-15 |