| NPI | 1114340064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 10998) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202009192) |
| 183500000X Pharmacist (Licence: PA RP032116L) | |
| Enumeration Date | 2014-01-29 |
| Last Update Date | 2015-10-19 |