| NPI | 1942083399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 66939) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH033657) |
| 183500000X Pharmacist (Licence: NY 067916) | |
| Enumeration Date | 2023-08-17 |
| Last Update Date | 2023-08-17 |