| NPI | 1235510108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 201-701-3181) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 53639) |
| Enumeration Date | 2015-06-16 |
| Last Update Date | 2020-04-29 |