| NPI | 1619482890 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NE 11630) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA 19766) |
| Enumeration Date | 2017-12-09 |
| Last Update Date | 2018-03-17 |