| NPI | 1235791971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 7598176-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 11118-40) |
| 183500000X Pharmacist (Licence: AZ S023262) | |
| 183500000X Pharmacist (Licence: NV 19894) | |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2019-07-02 |