| NPI | 1891061503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 29834) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: LA 13919) |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2024-05-21 |