| NPI | 1518243393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 25797) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302035048) |
| Enumeration Date | 2011-10-25 |
| Last Update Date | 2016-12-14 |