| NPI | 1568062412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 18010) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202207509) |
| Enumeration Date | 2020-10-29 |
| Last Update Date | 2020-10-29 |