| NPI | 1013463173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302041140) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 28RI03456400) |
| 183500000X Pharmacist (Licence: TX 51186) | |
| Enumeration Date | 2016-08-29 |
| Last Update Date | 2016-08-29 |