| NPI | 1750746301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: TX 19393) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: LA 9812) |
| Enumeration Date | 2015-12-28 |
| Last Update Date | 2015-12-28 |