| NPI | 1053698415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NE 14371) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN 120642) |
| 183500000X Pharmacist (Licence: WI 16479-040) | |
| Enumeration Date | 2011-11-12 |
| Last Update Date | 2018-05-08 |