| NPI | 1447675574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SD 6130) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 63430) |
| Enumeration Date | 2014-02-26 |
| Last Update Date | 2020-02-03 |