| NPI | 1184150468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SD 6303) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MN RPH5770) |
| Enumeration Date | 2017-05-05 |
| Last Update Date | 2017-05-05 |