| NPI | 1457760720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: AL 17650) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS46468) |
| Enumeration Date | 2014-08-12 |
| Last Update Date | 2014-08-12 |