| NPI | 1124668090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ID P7629) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 15005) |
| Enumeration Date | 2020-01-08 |
| Last Update Date | 2020-01-08 |