| NPI | 1760017073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA PH235998) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NC 25633) |
| Enumeration Date | 2020-03-06 |
| Last Update Date | 2020-03-06 |