| NPI | 1174827372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00007561) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 19923) |
| Enumeration Date | 2011-01-03 |
| Last Update Date | 2017-01-11 |