| NPI | 1629378773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TN 40773) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S015073) |
| 171100000X Acupuncturist (Licence: AZ 0928) | |
| Enumeration Date | 2010-10-22 |
| Last Update Date | 2016-11-15 |