| NPI | 1801481247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 19901) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 40092) |
| 183500000X Pharmacist (Licence: SC 35888) | |
| 183500000X Pharmacist (Licence: WV RP0007830) | |
| Enumeration Date | 2021-03-08 |
| Last Update Date | 2021-03-08 |