| NPI | 1619312543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 19595) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202211228) |
| Enumeration Date | 2013-05-06 |
| Last Update Date | 2014-05-28 |