| NPI | 1114335668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 25671) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA 024534) |
| 183500000X Pharmacist (Licence: SC 035410) | |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2015-12-23 |