| NPI | 1265713291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 013544) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL ps40142) |
| 183500000X Pharmacist (Licence: MI 5302036625) | |
| Enumeration Date | 2011-09-05 |
| Last Update Date | 2018-02-16 |