| NPI | 1760857908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 227203) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 10964) |
| Enumeration Date | 2015-12-13 |
| Last Update Date | 2015-12-13 |