| NPI | 1023663903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH239513) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 29059) |
| 183500000X Pharmacist (Licence: MA PH293513) | |
| Enumeration Date | 2019-08-07 |
| Last Update Date | 2020-12-01 |