| NPI | 1063038842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 24576) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: HI 2460) |
| 183500000X Pharmacist (Licence: CA 37418) | |
| Enumeration Date | 2020-06-17 |
| Last Update Date | 2020-06-17 |