| NPI | 1275013989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: WY TL3831) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: GA RPH030322) |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2018-08-21 |