| NPI | 1376076844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2012024149) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-15160) |
| Enumeration Date | 2017-04-11 |
| Last Update Date | 2017-04-11 |