| NPI | 1760802714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MI 5302039725) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: AZ S019531) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2016-01-21 |