| NPI | 1023480340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 22668) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 22533) |
| Enumeration Date | 2015-10-26 |
| Last Update Date | 2019-04-26 |