| NPI | 1205312659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: ME PR47054) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 61215) |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2018-10-26 |