| NPI | 1083066682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH236734) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CT 0013435) |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2019-02-20 |