| NPI | 1013558915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 6159289) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 17586) |
| Enumeration Date | 2019-10-01 |
| Last Update Date | 2019-10-01 |