| NPI | 1013400191 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2017037463) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-103088) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2018-06-12 |