| NPI | 1376842187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 17535) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP439796) |
| 183500000X Pharmacist (Licence: IL 292972) | |
| Enumeration Date | 2011-03-18 |
| Last Update Date | 2021-04-10 |