| NPI | 1750826640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: KY 018095) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: VA 0202214010) |
| Enumeration Date | 2016-12-30 |
| Last Update Date | 2016-12-30 |