| NPI | 1164773826 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2012028852) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: CO 0019604) |
| Enumeration Date | 2012-09-21 |
| Last Update Date | 2022-10-27 |