| NPI | 1396269874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 21811) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 23110) |
| Enumeration Date | 2017-07-27 |
| Last Update Date | 2019-03-22 |