| NPI | 1568850857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NC 24556) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SC 35903) |
| Enumeration Date | 2015-01-08 |
| Last Update Date | 2016-04-11 |