| NPI | 1003184029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 21614) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 48953) |
| Enumeration Date | 2011-12-05 |
| Last Update Date | 2020-07-01 |