| NPI | 1780136754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: SC 42387) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: TX 59736) |
| Enumeration Date | 2016-10-26 |
| Last Update Date | 2020-03-14 |