| NPI | 1194052712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 40670) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS44473) |
| 183500000X Pharmacist (Licence: MA 1067119) | |
| Enumeration Date | 2009-11-04 |
| Last Update Date | 2020-12-31 |