| NPI | 1083213490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 29742) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202215119) |
| Enumeration Date | 2020-10-19 |
| Last Update Date | 2020-10-19 |