| NPI | 1215458112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP451474) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MD 25058) |
| Enumeration Date | 2017-06-29 |
| Last Update Date | 2021-08-31 |