| NPI | 1184225070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NM RP00009392) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WY 4254) |
| Enumeration Date | 2020-11-05 |
| Last Update Date | 2020-11-05 |