| NPI | 1639696974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: FL ps34047) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MI 5302030449) |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2017-08-28 |