| NPI | 1285155952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302045658) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 019240) |
| Enumeration Date | 2017-07-03 |
| Last Update Date | 2017-07-03 |