| NPI | 1629526736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: UT 5543677-1701) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WY 3876) |
| Enumeration Date | 2016-09-18 |
| Last Update Date | 2016-09-18 |