| NPI | 1851781629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 49148) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS46396) |
| 183500000X Pharmacist (Licence: NV 21574) | |
| 183500000X Pharmacist (Licence: VT 133.0133164) | |
| Enumeration Date | 2015-01-30 |
| Last Update Date | 2023-08-10 |