| NPI | 1255715447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NH R1133) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA 18084) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2015-07-17 |