| NPI | 1518364488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 28567) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202213622) |
| Enumeration Date | 2014-11-20 |
| Last Update Date | 2019-08-01 |