| NPI | 1366796302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 68534) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302039014) |
| Enumeration Date | 2012-10-30 |
| Last Update Date | 2022-08-18 |