| NPI | 1164810917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 22920) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 24234) |
| Enumeration Date | 2015-01-02 |
| Last Update Date | 2015-01-02 |