| NPI | 1902350762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 68239) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: ID P11210) |
| 183500000X Pharmacist (Licence: VT 033.0135310) | |
| 183500000X Pharmacist (Licence: IL 051299711) | |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2024-12-09 |