| NPI | 1972293041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 23985) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2021050249) |
| 183500000X Pharmacist (Licence: TX 70344) | |
| 183500000X Pharmacist (Licence: NV 23686) | |
| Enumeration Date | 2023-05-11 |
| Last Update Date | 2023-05-11 |