| NPI | 1518501642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 4898357-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NV 18088) |
| Enumeration Date | 2019-10-31 |
| Last Update Date | 2019-10-31 |