| NPI | 1366893505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH235367) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NH R2577) |
| Enumeration Date | 2016-06-29 |
| Last Update Date | 2020-11-27 |