| NPI | 1568940526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: IA 23347) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-106248) |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2018-08-01 |