| NPI | 1912508490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 23908) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 17501) |
| 183500000X Pharmacist (Licence: TX 54497) | |
| Enumeration Date | 2020-11-03 |
| Last Update Date | 2020-11-03 |