| NPI | 1013345933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 20546) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 120954) |
| Enumeration Date | 2013-11-01 |
| Last Update Date | 2021-10-31 |