| NPI | 1700160298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 50666) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: DC PH100001325) |
| Enumeration Date | 2011-10-04 |
| Last Update Date | 2015-12-11 |