| NPI | 1861212276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 26686) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 68828) |
| Enumeration Date | 2024-10-11 |
| Last Update Date | 2024-10-11 |