| NPI | 1538599295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: LA 020912) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: OR 0013798) |
| Enumeration Date | 2013-11-16 |
| Last Update Date | 2019-10-22 |