| NPI | 1205248390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NV 19304) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 41627) |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2019-07-05 |