| NPI | 1407131469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 11504419-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S018536) |
| Enumeration Date | 2011-10-20 |
| Last Update Date | 2021-12-02 |