| NPI | 1073982062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NH 3621) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH232891) |
| 183500000X Pharmacist (Licence: TX 54373) | |
| Enumeration Date | 2015-09-19 |
| Last Update Date | 2015-09-19 |