| NPI | 1588176689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302041971) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 64317) |
| Enumeration Date | 2017-10-30 |
| Last Update Date | 2020-11-11 |