| NPI | 1952998122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 63186) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM RP00010113) |
| Enumeration Date | 2020-12-22 |
| Last Update Date | 2025-10-09 |