| NPI | 1700401296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: PA RP450901) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: FL PS55223) |
| Enumeration Date | 2020-06-10 |
| Last Update Date | 2020-06-10 |