| NPI | 1194770321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 11298) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DC 2642) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2021-08-13 |