| NPI | 1356998140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SD 54643) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 54643) |
| 183500000X Pharmacist (Licence: FL PS39161) | |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2019-08-26 |