| NPI | 1700212305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SD R6248) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: IA IA22077) |
| Enumeration Date | 2013-09-16 |
| Last Update Date | 2015-02-19 |