| NPI | 1063849206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 14070) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-11335) |
| 183500000X Pharmacist (Licence: NE 13606) | |
| Enumeration Date | 2013-10-02 |
| Last Update Date | 2022-02-02 |