| NPI | 1104250497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP453319) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S020088) |
| Enumeration Date | 2013-08-22 |
| Last Update Date | 2021-03-29 |