| NPI | 1205141553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 6213279-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: UT 6213279-8911) |
| Enumeration Date | 2010-08-11 |
| Last Update Date | 2022-07-21 |