| NPI | 1750640280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MD 23811) |
| Additional Taxonomies | 183700000X Pharmacy Technician (Licence: MD T08093) |
| Enumeration Date | 2012-05-03 |
| Last Update Date | 2015-12-01 |