| NPI | 1780902403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 183500000X Pharmacist (Licence: MA 20430) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: MA PH20430) |
| Enumeration Date | 2010-05-05 |
| Last Update Date | 2020-10-22 |