| NPI | 1053540062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 24903) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 122629) |
| Enumeration Date | 2009-07-11 |
| Last Update Date | 2022-07-24 |