| NPI | 1245690833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 25691) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 16023) |
| Enumeration Date | 2016-02-25 |
| Last Update Date | 2016-02-25 |