| NPI | 1649690439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 56959) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TN 37504) |
| Enumeration Date | 2014-04-21 |
| Last Update Date | 2019-06-20 |