| NPI | 1831702737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 68401) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 10962516) |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2023-08-20 |