| NPI | 1417385014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 7725489-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR RPH-0013823) |
| Enumeration Date | 2013-10-17 |
| Last Update Date | 2019-11-20 |