| NPI | 1760861108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 113678) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WI 15856-040) |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2015-05-19 |