| NPI | 1649768250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MO 2016023700) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KS 1-100592) |
| Enumeration Date | 2018-04-30 |
| Last Update Date | 2018-04-30 |