| NPI | 1790214427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 61733) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 24760) |
| Enumeration Date | 2017-06-06 |
| Last Update Date | 2021-08-09 |