| NPI | 1790544302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP459422) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 29420) |
| Enumeration Date | 2024-03-18 |
| Last Update Date | 2025-07-23 |