| NPI | 1528605466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: CO 22615) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WY 4129) |
| Enumeration Date | 2019-12-10 |
| Last Update Date | 2019-12-10 |