| NPI | 1992115588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 24518) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NM RP00007752) |
| 183500000X Pharmacist (Licence: TX 50775) | |
| Enumeration Date | 2014-05-05 |
| Last Update Date | 2020-09-25 |