| NPI | 1760866495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MN 121671) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: SD 6039) |
| Enumeration Date | 2015-07-13 |
| Last Update Date | 2015-07-13 |