| NPI | 1134584360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 56432) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MO 2012032805) |
| Enumeration Date | 2015-12-14 |
| Last Update Date | 2015-12-14 |