| NPI | 1700499472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 27450) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: KY 020942) |
| Enumeration Date | 2020-08-24 |
| Last Update Date | 2020-08-24 |