| NPI | 1609224831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH233862) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 54860) |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2016-05-27 |