| NPI | 1104372937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 19316) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS55310) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2018-04-12 |