| NPI | 1215166863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 21054) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NE 14529) |
| Enumeration Date | 2009-07-03 |
| Last Update Date | 2022-03-29 |