| NPI | 1558918649 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 183500000X Pharmacist (Licence: GA rph022984) | 
| Additional Taxonomies | 183500000X Pharmacist (Licence: LA PST.003236) | 
| 183500000X Pharmacist (Licence: FL PS57751) | |
| Enumeration Date | 2019-08-22 | 
| Last Update Date | 2019-08-22 |