| NPI | 1124403621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NE 15957) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 6149388-1701) |
| Enumeration Date | 2015-07-25 |
| Last Update Date | 2020-06-19 |